Controversy over pictorial health warnings covering the front and back of the tobacco packs

The Minister of Health of Sri Lanka made a direction by a special gazette notification in August 2012 to introduce pictorial health warnings covering 80 per cent of the front and back of the tobacco packs and to declare toxic substances contained in cigarettes, in each pack.

Implementation of the regulation of pictorial health warnings on cigarette packs (Article 11 of the FCTC) is a requirement of the Framework Convention on Tobacco Control (FCTC) of the World Health Organization, by all the Parties to the treaty within 3 years from the date of ratification of the treaty. Sri Lanka became a Party to the FCTC in 2003.

The tobacco industry in Sri Lanka which is a monopoly of Sri Lanka has filed a court case against the decision of the Minister of Health. Currently there is a debate regarding the size of the warnings.

Dr. Prabath Wickrama, a Psychiatrist attached to the General Hospital, Trincomalee and the National Cancer Institute, Maharagama, Sri Lanka, expressed his views on the matter; “The interesting fact is British American Tobacco Company (BAT) who owns Sri Lanka tobacco company and which also owns tobacco companies in Australia and Thailand has agreed to display graphic warnings on cigarette packs on those countries respectively 75% and 85%. The very same industry in Sri Lanka is hesitating to give that opportunity to our people.”

Over 50 countries have adopted to display pictorial health warnings on cigarette packets which are a requirement of the WHO Framework Convention on Tobacco Control for its Parties.

Research gives a decisive answer to this debate. Only 80% size of warning result in the whole expected outcome of attaching pictorial warnings to cigarettes.

“There is no doubt that cigarette smoking is the biggest health hazard and the financial threat faced by Sri Lankans at present. It is estimated that 12000-20000 people die due to smoking each year in Sri Lanka. Thus every two years more Sri Lankans die due to smoking compared to deaths occurred due to the Tsunami. Net profit of tobacco sales in the country for 2013 is estimated to be over Rs 11,000,000,000/= which being the profit is far less than what is actually paid by the consumers. About 50% of young people who start smoking will die prematurely due to smoking. Morbidity statistics are even higher. Considering the psychiatry aspect alone cigarette addiction itself is classified a Mental Illness. Smoking is not only a leading physical cause of erectile dysfunction in males but also reduces the sexual appeal of the user to opposite sex.

When considering these alarming facts we are faced with the question why people continue to smoke and why young people start smoking. This has a simple answer. The industry does an advanced and sophisticated advertising campaign to attract the consumers. Especially these marketing strategies are developed to address the emotional challenges of adolescents and young adults and attract them to the market. Industry try to couple personality traits adolescents admire with smoking. Most important aspect of this advertising is through attractive packaging.

By nature humans have a vast potentiality to be fashioned by observations. Most our values, styles of thinking and behaviour patterns are shaped through observations of our environment. Furthermore most of this shaping process occurs without our conscious knowledge. Tobacco industry uses this human plasticity to propagate their products.

The sophistication of today’s cigarette packs is the culmination of decades of industry research into how color, images, logos, fonts, and the three-dimensional pack can be manipulated to influence personality, sensory and health perceptions of the cigarette.

Now we are faced with the problem how to overcome this challenge enforced on our society by the industry. There is a Sinhalese saying that if a person fell in to a well they must climb back along the same route he fell down. Accordingly cigarette packaging itself is a route to reach and help the current users and the vulnerable adolescents. This can be done in two ways, by making packages less attractive and displaying warning labels on packages. Experiments have shown that when brand elements such as color, branded fonts, and imagery were progressively removed from cigarette packs adolescents not only perceives cigarettes less attractive, they get more negative expectations on cigarette taste. Pack appeal reduces further when pictorial warnings are attached to packs and when the size of the warning was increased from 30% to 80% of the package size.

Though there are numerous awareness programs on the risks of smoking, studies show that a large number of smokers have inadequate grasp of the health effects of smoking. While some smokers have some idea that tobacco use is harmful, they undervalue the severity and magnitude of the health risks. Knowledge of the health risks of smoking is even lower among people who are poor and uneducated because of limited access to knowledge about the hazards of smoking. Numerous researches show that clear pictorial warnings of packages reaches the consumers effectively. Graphics with convey an emotional massage is known to be more effective. Pictures also increase the message’s accessibility by people with low levels of literacy and can help smokers visualize tobacco-caused diseases. This self-visualisation is a strong motivational factor to quit smoking. A good example is reported from USA. On the day the U.S. Food and Drug Administration unveiled the new graphic warning the USA helpline which help people to quit smoking got more than double the usual number of calls .

“The size of the warning has proven to be important as well. Research conducted in Canada found that warnings occupying 75% of a cigarette packets cover were more effective in eliciting negative perceptions and conveying information about the health risks of smoking to adult smokers as compared with warnings occupying 50% of a branded pack’s face. More critical finding of this research was that to elicit a similar response among smoking adolescents the warning size should be more than 80%” stated Dr. Wickrama.